1
|
Das CJ, Razik A, Tchoquessi RLN, Ramachandran A, Singh P, Rednam N, Kundra V. Multimodality imaging of urinary tract tuberculosis. Abdom Radiol (NY) 2024:10.1007/s00261-024-04526-y. [PMID: 39207518 DOI: 10.1007/s00261-024-04526-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/06/2024] [Accepted: 08/10/2024] [Indexed: 09/04/2024]
Abstract
Imaging is a key component of diagnosis and treatment response evaluation of urinary tract tuberculosis (UT TB). Tuberculosis can have a long latency, but if found early, one may have the opportunity to prevent complications such as ureteral strictures, obstructive nephropathy, contracted (thimble) bladder, renal parenchymal destruction/calcification, and renal failure. Imaging can aid in diagnosis and differential diagnoses, evaluate the extent of disease and complications, and guide image-directed biopsy, surgical planning, and evaluation of treatment response. Imaging abnormalities in the renal parenchyma and urinary tract at different stages of the disease, lymphadenopathy, and extra-urinary tract organ involvement are suggestive of UT TB. Recent advances in imaging modalities aid in UT TB diagnosis, follow-up, and guiding treatment.
Collapse
Affiliation(s)
- Chandan J Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Abdul Razik
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rosy Linda Njonkou Tchoquessi
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA
| | - Anupama Ramachandran
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Prabhjot Singh
- Department of Urology, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA
| | - Vikas Kundra
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD, 21201, USA.
- Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD, USA.
| |
Collapse
|
2
|
Santamarina MG, Necochea Raffo JA, Lavagnino Contreras G, Recasens Thomas J, Volpacchio M. Predominantly multiple focal non-cystic renal lesions: an imaging approach. Abdom Radiol (NY) 2024:10.1007/s00261-024-04440-3. [PMID: 38913137 DOI: 10.1007/s00261-024-04440-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024]
Abstract
Multiple non-cystic renal lesions are occasionally discovered during imaging for various reasons and poses a diagnostic challenge to the practicing radiologist. These lesions may appear as a primary or dominant imaging finding or may be an additional abnormality in the setting of multiorgan involvement. Awareness of the imaging appearance of the various entities presenting as renal lesions integrated with associated extrarenal imaging findings along with clinical information is crucial for a proper diagnostic approach and patient work-up. This review summarizes the most relevant causes of infectious, inflammatory, vascular, and neoplastic disorders presenting as predominantly multiple focal non-cystic lesions.
Collapse
Affiliation(s)
- Mario G Santamarina
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., Viña del Mar, Provincia de Valparaíso, Chile.
- Radiology Department, Hospital Dr. Eduardo Pereira, Valparaiso, Chile.
| | - Javier A Necochea Raffo
- Radiology Department, Hospital Naval Almirante Nef, Subida Alesandri S/N., Viña del Mar, Provincia de Valparaíso, Chile
| | | | - Jaime Recasens Thomas
- Departamento de Radiología, Escuela de Medicina, Universidad de Valparaíso, Valparaiso, Chile
| | - Mariano Volpacchio
- Radiology Department, Centro de Diagnóstico Dr. Enrique Rossi, Buenos Aires, Argentina
| |
Collapse
|
3
|
Mahomed N, Kilborn T, Smit EJ, Chu WCW, Young CYM, Koranteng N, Kasznia-Brown J, Winant AJ, Lee EY, Sodhi KS. Tuberculosis revisted: classic imaging findings in childhood. Pediatr Radiol 2023; 53:1799-1828. [PMID: 37217783 PMCID: PMC10421797 DOI: 10.1007/s00247-023-05648-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023]
Abstract
Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.
Collapse
Affiliation(s)
- Nasreen Mahomed
- University of Witwatersrand, 7 York Road Parktown, Johannesburg, 2193, South Africa.
| | - Tracy Kilborn
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Elsabe Jacoba Smit
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Winnie Chiu Wing Chu
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Catherine Yee Man Young
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nonceba Koranteng
- University of Witwatersrand, 7 York Road Parktown, Johannesburg, 2193, South Africa
| | | | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, USA
| | - Kushaljit Singh Sodhi
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| |
Collapse
|
4
|
Das CJ, Rednam N, Vora Z, Aggarwal A, Chandrashekhara SH, Kundra V. Abdominal visceral tuberculosis: a malignancy mimic. Abdom Radiol (NY) 2023; 48:2705-2715. [PMID: 37204509 PMCID: PMC10197054 DOI: 10.1007/s00261-023-03939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/20/2023]
Abstract
The purpose is to discuss abdominal tuberculosis mimicking malignancy involving the abdominal viscera. TB of the abdominal viscera is common, especially in countries where tuberculosis is endemic and in pockets of non-endemic countries. Diagnosis is challenging as clinical presentations are often non-specific. Tissue sampling may be necessary for definitive diagnosis. Awareness of the early and late disease imaging appearances of abdominal tuberculosis involving the viscera that can mimic malignancy can aid detecting TB, providing a differential diagnosis, assessing extent of spread, guiding biopsy, and evaluating response.
Collapse
Affiliation(s)
- Chandan J. Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Nikita Rednam
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
| | - Zainab Vora
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Ankita Aggarwal
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - S. H. Chandrashekhara
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi, 110029 India
| | - Vikas Kundra
- Department of Diagnostic Radiology and Nuclear Medicine, Program in Experimental Therapeutics, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD 21201 USA
| |
Collapse
|
5
|
Taneja R, Taneja N. Urological problems in elderly patients of tuberculosis. Indian J Tuberc 2022; 69 Suppl 2:S295-S300. [PMID: 36400526 DOI: 10.1016/j.ijtb.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023]
Abstract
Development of tuberculosis is closely linked to poor socioeconomic condition, poor immune functioning and mental health including depression and anxiety. Elderly population becomes an important target group for the disease and deserves special attention. Unique problem with genito urinary tuberculosis (GUTB) in elderly population is the diagnosis. One of the earliest symptoms of GUTB is increased urinary frequency which a large majority in elderly population may already have, owing to their enlarged prostates or an overactive bladder/detrusor over activity mediated centrally or peripherally, which are not uncommon in this group. When left undiagnosed and thereby untreated, GUTB usually leads to irreversible tissue damage and consequences range from abscesses, small capacity urinary bladder to renal failure.
Collapse
Affiliation(s)
- Rajesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India.
| | - Nilesh Taneja
- Urology and Robotic Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| |
Collapse
|
6
|
Merchant SA, Shaikh MJS, Nadkarni P. Tuberculosis conundrum - current and future scenarios: A proposed comprehensive approach combining laboratory, imaging, and computing advances. World J Radiol 2022; 14:114-136. [PMID: 35978978 PMCID: PMC9258306 DOI: 10.4329/wjr.v14.i6.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/17/2022] [Accepted: 05/28/2022] [Indexed: 02/06/2023] Open
Abstract
Tuberculosis (TB) remains a global threat, with the rise of multiple and extensively drug resistant TB posing additional challenges. The International health community has set various 5-yearly targets for TB elimination: mathematical modelling suggests that a 2050 target is feasible with a strategy combining better diagnostics, drugs, and vaccines to detect and treat both latent and active infection. The availability of rapid and highly sensitive diagnostic tools (Gene-Xpert, TB-Quick) will vastly facilitate population-level identification of TB (including rifampicin resistance and through it, multi-drug-resistant TB). Basic-research advances have illuminated molecular mechanisms in TB, including the protective role of Vitamin D. Also, Mycobacterium tuberculosis impairs the host immune response through epigenetic mechanisms (histone-binding modulation). Imaging will continue to be key, both for initial diagnosis and follow-up. We discuss advances in multiple imaging modalities to evaluate TB tissue changes, such as molecular imaging techniques (including pathogen-specific positron emission tomography imaging agents), non-invasive temporal monitoring, and computing enhancements to improve data acquisition and reduce scan times. Big data analysis and Artificial Intelligence (AI) algorithms, notably in the AI sub-field called “Deep Learning”, can potentially increase the speed and accuracy of diagnosis. Additionally, Federated learning makes multi-institutional/multi-city AI-based collaborations possible without sharing identifiable patient data. More powerful hardware designs - e.g., Edge and Quantum Computing- will facilitate the role of computing applications in TB. However, “Artificial Intelligence needs real Intelligence to guide it!” To have maximal impact, AI must use a holistic approach that incorporates time tested human wisdom gained over decades from the full gamut of TB, i.e., key imaging and clinical parameters, including prognostic indicators, plus bacterial and epidemiologic data. We propose a similar holistic approach at the level of national/international policy formulation and implementation, to enable effective culmination of TB’s endgame, summarizing it with the acronym “TB - REVISITED”.
Collapse
Affiliation(s)
- Suleman Adam Merchant
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai 400022, Maharashtra, India
| | - Mohd Javed Saifullah Shaikh
- Department of Radiology, North Bengal Neuro Centre, Jupiter magnetic resonance imaging, Diagnostic Centre, Siliguri 734003, West Bengal, India
| | - Prakash Nadkarni
- College of Nursing, University of Iowa, Iowa 52242, IA, United States
| |
Collapse
|
7
|
Madaan PK, Ghasi RG. Conventional uroradiology with excretory urography: a forgotten art? Br J Radiol 2022; 95:20210949. [PMID: 34990261 PMCID: PMC9153722 DOI: 10.1259/bjr.20210949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Excretory urography (EU) had been the most frequently performed imaging modality for uroradiology in the past. With the advances in ultrasonography, and development of cross-sectional urography with CT and MRI, EU is now seldom performed. Consequently, there has been a decline of expertise in this technique. However, EU has multiple advantages such as dynamic nature, easy availability, low cost and radiation burden. These render it potentially very valuable in specific indications like congenital anomalies, urothelial lesions and urinary leaks. This review intends to emphasize the current day relevance of excretory urography, outline the key points of the technique, and describe the pearls and pitfalls of interpretation.
Collapse
Affiliation(s)
| | - Rohini Gupta Ghasi
- Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| |
Collapse
|
8
|
So PNH, Villanueva ART. Serologic and urinary characteristics of laboratory-confirmed genitourinary tuberculosis at a tertiary hospital in the Philippines. BMC Urol 2021; 21:125. [PMID: 34503465 PMCID: PMC8431859 DOI: 10.1186/s12894-021-00888-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Genitourinary tuberculosis (GUTB) is known to cause high rates of structural organ damage, however, literature on its biochemical manifestations is limited. Additionally, local studies in the Philippine setting, where cases are rampant, are few and dated. This study aimed to determine the serologic and urinary profile of patients with GUTB admitted at a tertiary hospital within January 2009 to March 2020 and their association with short-term outcomes. METHODS This retrospective study included 112 patients with laboratory-confirmed GUTB (i.e., positivity in acid-fast smear, polymerase chain reaction, culture, or histology). Demographic data, clinical characteristics, laboratory and radiologic findings, histopathology reports, treatment, and short-term outcomes were recorded. RESULTS Bladder (54.5%) and kidney (36.4%) were the most affected organs. The male:female ratio was 1:1.15, and the mean age was 35.79 ± 18.29 years. Weakness (14.29%) was the most common chief complaint. A majority presented with anemia (83.04%), while several had leukocytosis (41.96%) and thrombocytosis (26.79%). Hypoalbuminemia (58.10%), impairment of renal function (36.94%), and electrolyte abnormalities such as hyponatremia (50.93%), hypercalcemia (20.19%), and hypokalemia (21.82%) were common. Proteinuria (67.96%) and pyuria (67.96%) were the most frequent abnormal findings, followed by hematuria (51.46%), acidic urine (45.63%) and low specific gravity (31.07%). Age, leukocytosis, and the need for pressors were all significantly associated with mortality (p values of <0.001, 0.010, and <0.001, respectively). CONCLUSIONS The young age at presentation with severe clinical and laboratory manifestations may reflect local epidemiology as TB continues to be widespread in the country. Apart from the more commonly cited abnormalities in literature, multiple electrolyte imbalances and urinary concentration defects were also observed in many cases, possibly indicating tubulointerstitial involvement-a complication increasingly mentioned in case reports. As several patient characteristics were found to be associated with the high mortality rates observed in the study, further research is recommended to explore predictive modeling.
Collapse
Affiliation(s)
- Paolo Nikolai H So
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines.
| | - Anthony Russell T Villanueva
- Division of Nephrology, Department of Medicine, University of the Philippines Manila - Philippine General Hospital, Taft Avenue, Ermita, 1000, Manila, Philippines
| |
Collapse
|
9
|
Dorval G, Berteloot L, Pio L, Boyer O, Blanc T. A rare cause of transitory hematuria and urinary tract dysfunction in children: Answers. Pediatr Nephrol 2021; 36:2131-2135. [PMID: 33768327 DOI: 10.1007/s00467-021-05006-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 01/24/2021] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Guillaume Dorval
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France. .,Université de Paris, Faculté de Médecine, Paris, France.
| | - Laureline Berteloot
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service d'Imagerie Pédiatrique, Paris, France
| | - Luca Pio
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| | - Olivia Boyer
- AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service Néphrologie Pédiatrique, Centre de référence Marhea, 149 Rue de Sèvres, 75015, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Thomas Blanc
- Université de Paris, Faculté de Médecine, Paris, France.,AP-HP, Hôpital Universitaire Necker-Enfants Malades, Service de Chirurgie Pédiatrique, Paris, France
| |
Collapse
|
10
|
Naeem M, Zulfiqar M, Siddiqui MA, Shetty AS, Haq A, Varela C, Siegel C, Menias CO. Imaging Manifestations of Genitourinary Tuberculosis. Radiographics 2021; 41:1123-1143. [PMID: 34048278 DOI: 10.1148/rg.2021200154] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis (TB) involvement. The imaging features of genitourinary TB are protean and can mimic other entities, including malignancy, and pose a diagnostic dilemma. Hematogenous seeding and lymphatic spread of mycobacteria from pulmonary, tonsillar, and nodal TB are implicated in the pathogenesis of genitourinary TB. In addition, contiguous extension from the urinary tract and sexual transmission are described as sources of genital TB. Genitourinary TB can be indolent and results in nonspecific signs and symptoms; thus, imaging has a vital role in the working diagnosis for these cases. Classic uroradiologic signs of genitourinary TB are primarily described from the era of intravenous urography and conventional radiography. Now, CT, CT urography, MRI, and US are used in the diagnosis and management. Familiarity with the imaging features of genitourinary TB may help guide the diagnosis and, in turn, lead to timely management. US has a vital role in the evaluation of scrotal and female genital TB. MRI offers superior soft-tissue contrast resolution and excellent depiction of anatomic detail. The various imaging manifestations of genitourinary TB are highlighted. ©RSNA, 2021.
Collapse
Affiliation(s)
- Muhammad Naeem
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Maria Zulfiqar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Mohammed Azfar Siddiqui
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Anup S Shetty
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Adeel Haq
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Cristian Varela
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Cary Siegel
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (M.N., M.Z., A.S.S., C.S.); Department of Radiology, Division of Body Imaging, University of Missouri Health System, Columbia, Mo (M.A.S.); Department of Radiology, Division of Body Imaging, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan (A.H.); Department of Imaging, Division of Body Imaging, Clinica Davila, Recoleta, Chile (C.V.); and Department of Radiology, Division of Abdominal Imaging, Mayo Clinic Arizona, Scottsdale, Ariz (C.O.M.)
| |
Collapse
|
11
|
Radwan A, Menias CO, El-Diasty MT, Etchison AR, Elshikh M, Consul N, Nassar S, Elsayes KM. Multimodality Imaging of Genitourinary Tuberculosis. Curr Probl Diagn Radiol 2020; 50:867-883. [PMID: 33272721 DOI: 10.1067/j.cpradiol.2020.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/10/2020] [Accepted: 10/16/2020] [Indexed: 01/27/2023]
Abstract
Tuberculosis (TB) prevalence has increased over the past few decades, especially in the developing world. The genitourinary tract is the most common extra-pulmonary location of TB. Symptoms of genitourinary TB are often vague. Diagnosis of genitourinary TB requires a high level of clinical suspicion. Healthcare providers must be familiar with genitourinary TB imaging features on different imaging modalities and how to correlate these findings with urine studies and histologic analysis to definitively diagnose genitourinary TB.
Collapse
Affiliation(s)
- Ahmed Radwan
- University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Mohamed T El-Diasty
- Radiology department, King AbdulAziz University Hospital, Jeddah, Saudi Arabia
| | | | | | | | - Sameh Nassar
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | |
Collapse
|
12
|
Kardani AK, Subandiyah K. Genitourinary tuberculosis in 2-year-old indonesian boy with malnutrition: A rare case. Urol Case Rep 2020; 33:101365. [PMID: 33102064 PMCID: PMC7573958 DOI: 10.1016/j.eucr.2020.101365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 07/26/2020] [Accepted: 07/28/2020] [Indexed: 11/29/2022] Open
Abstract
Genitourinary tuberculosis is a primary target of hematogenous infections and is the most common site of extra-pulmonary tuberculosis. A 2-year-old Indonesian boy with genitourinary tuberculosis with family history of tuberculosis. Radiological work-ups show pulmonary miliary tuberculosis, complication of hydronephrosis and ureteral kinking. Centrifuge-urine smear shows acid-resistant bacillus. Anthropometric measured was similar a 1-years-2-months-old boy. The biological activity of tuberculosis can only be assessed by cultivating mycobacteria. The patient was treated with anti-tuberculosis regiments and shows improvement on clinical presentation. He received nutritional intake based on the WHO formula (F75, F100, F135). This patient should undergo reconstructive surgery but refuse.
Collapse
Affiliation(s)
- Astrid Kristina Kardani
- Nephrology Division, Department of Pediatric, Faculty of Medicine, Universitas Brawijaya - Dr. Saiful Anwar General Hospital, Malang, 65111, Indonesia
| | - Krisni Subandiyah
- Nephrology Division, Department of Pediatric, Faculty of Medicine, Universitas Brawijaya - Dr. Saiful Anwar General Hospital, Malang, 65111, Indonesia
| |
Collapse
|
13
|
Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary Tuberculosis: Pathophysiology and Imaging Findings. Radiographics 2020; 39:2023-2037. [PMID: 31697616 DOI: 10.1148/rg.2019190109] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Extrapulmonary tuberculosis (TB) represents approximately 15% of all TB infections. It is difficult to diagnose on the basis of imaging characteristics and clinical symptoms, and biopsy is required in many cases. Radiologists must be aware of the imaging findings of extrapulmonary TB to identify the condition in high-risk patients, even in the absence of active pulmonary infection. In extrapulmonary TB, the lymphatic system is most frequently affected. The presence of necrotic lymph nodes and other organ-specific imaging features increases the diagnostic probability of extrapulmonary TB. Disseminated infection and central nervous system involvement are the most frequent manifestations in immunosuppressed patients. Renal disease can occur in immunocompetent patients with very long latency periods between the primary pulmonary infection and genitourinary involvement. In several cases, gastrointestinal, solid-organ, and peritoneal TB show nonspecific imaging findings. Tuberculous spondylitis is the most frequent musculoskeletal manifestation. It is usually diagnosed late and affects multiple vertebral segments with extensive paraspinal abscess. Articular disease is the second most frequent musculoskeletal manifestation, and synovitis is its predominant imaging finding.©RSNA, 2019.
Collapse
Affiliation(s)
| | - Martin Eduardo Renjifo
- From the Department of Radiology, Fundación Valle del Lili-Universidad Icesi, Carrera 98 #18-49, Cali, Colombia
| | - Francisco José Medina
- From the Department of Radiology, Fundación Valle del Lili-Universidad Icesi, Carrera 98 #18-49, Cali, Colombia
| |
Collapse
|
14
|
Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol 2019; 16:573-598. [PMID: 31548730 DOI: 10.1038/s41585-019-0228-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the most common cause of death from infectious disease worldwide. A substantial proportion of patients presenting with extrapulmonary TB have urogenital TB (UG-TB), which can easily be overlooked owing to non-specific symptoms, chronic and cryptic protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Delay in diagnosis results in disease progression, irreversible tissue and organ damage and chronic renal failure. UG-TB can manifest with acute or chronic inflammation of the urinary or genital tract, abdominal pain, abdominal mass, obstructive uropathy, infertility, menstrual irregularities and abnormal renal function tests. Advanced UG-TB can cause renal scarring, distortion of renal calyces and pelvic, ureteric strictures, stenosis, urinary outflow tract obstruction, hydroureter, hydronephrosis, renal failure and reduced bladder capacity. The specific diagnosis of UG-TB is achieved by culturing Mycobacterium tuberculosis from an appropriate clinical sample or by DNA identification. Imaging can aid in localizing site, extent and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring response to treatment. Drug-sensitive TB requires 6-9 months of WHO-recommended standard treatment regimens. Drug-resistant TB requires 12-24 months of therapy with toxic drugs with close monitoring. Surgical intervention as an adjunct to medical drug treatment is required in certain circumstances. Current challenges in UG-TB management include making an early diagnosis, raising clinical awareness, developing rapid and sensitive TB diagnostics tests, and improving treatment outcomes.
Collapse
|
15
|
Udare A, Abreu-Gomez J, Krishna S, McInnes M, Siegelman E, Schieda N. Imaging Manifestations of Acute and Chronic Renal Infection That Mimics Malignancy: How to Make the Diagnosis Using Computed Tomography and Magnetic Resonance Imaging. Can Assoc Radiol J 2019; 70:424-433. [PMID: 31537315 DOI: 10.1016/j.carj.2019.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To review the computed tomography and magnetic resonance imaging manifestations of acute and chronic renal infections that may mimic malignancy and to provide useful tips to establish an imaging diagnosis. CONCLUSION Acute and chronic bacterial pyelonephritis are usually readily diagnosed clinically and on imaging when the diagnosis is suspected based upon clinical presentation. When unsuspected, focal, extensive or mass-like, acute and chronic bacterial pyelonephritis may mimic infiltrative tumours such as urothelial cell carcinoma (UCC), lymphoma, and metastatic disease. Infection may be suspected when patients are young and otherwise healthy when there is marked associated perinephric changes and in the absence of metastatic adenopathy or disease elsewhere in the abdomen and pelvis. Renal abscesses, from bacterial or atypical microbial agents, can appear as complex cystic renal masses mimicking cystic renal cell carcinoma. Associated inflammatory changes in and around the kidney and local invasion favour infection. Emphysematous pyelonephritis can mimic necrotic or fistulizing tumour; however, infection is more likely and should always be considered first. Xanthogranulomatous pyelonephritis can mimic malignancy when focal or multifocal and in cases without associated renal calculi. Malacoplakia is an inflammatory process that may mimic malignancy and should be considered in patients with chronic infection. Bacillus Calmette-Guerin (BCG)-induced pyelonephritis is rare but can mimic renal malignancy and should be considered in patients presenting with a renal mass when being treated with BCG for urinary bladder UCC.
Collapse
Affiliation(s)
- Amar Udare
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jorge Abreu-Gomez
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Satheesh Krishna
- Joint Department of Medical Imaging, Toronto General Hospital, The University of Toronto, Toronto, Ontario, Canada
| | - Matthew McInnes
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan Siegelman
- Department of Radiology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
16
|
Laudelino JS, Farias Filho FT, Costa AFP, Santos VM. Mycobacterium abscessus urinary tract infection: case report. ACTA ACUST UNITED AC 2019; 42:124-126. [PMID: 31173040 PMCID: PMC7213923 DOI: 10.1590/2175-8239-jbn-2018-0260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/06/2019] [Indexed: 11/24/2022]
Abstract
Urinary tract infection is a serious public health issue that predominantly affects women. In men, it is more often associated with prostatic hyperplasia and bladder catheterization. Urogenital tuberculosis presents with nonspecific with nonspecific symptoms and the diagnosis can be made in the presence of sterile leukocyturia and recurrent infection with acid urine. Non-tuberculous mycobacteria or other non-tuberculosis mycobacteria are opportunistic pathogens that inhabit the soil, water or environment surfaces, and usually cause diseases in immunocompromised individuals. Mycobacterium abscessus is an agent that causes lung, skin and soft tissue hospital infections. Urinary tract infections by this pathogen are rare.
Collapse
|
17
|
Garrido-Abad P, Rodríguez-Cabello MÁ, Vera-Berón R, Platas-Sancho A. Bear Paw Sign: Xanthogranulomatous Pyelonephritis. J Radiol Case Rep 2019; 12:18-24. [PMID: 30647833 DOI: 10.3941/jrcr.v12i11.3415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis in which the involved areas of the kidneys are destroyed and replaced by foam cells. It usually occurs in immunocompromised middle-aged females with ureteral obstruction or chronic urinary tract infection induced by the formation of renal stones. We herein report the case of a 44-year-old woman, with a history of left kidney staghorn calculi and recurrent urinary tract infections. Abdominal computed tomography showed the 'bear paw' sign, typical appearance of XGP and patient underwent a nephrectomy with uneventful post-operative course.
Collapse
Affiliation(s)
- Pablo Garrido-Abad
- Department of Urology, Hospital Universitario Sanitas La Moraleja, Universidad Francisco de Vitoria, Madrid, Spain
| | | | | | - Arturo Platas-Sancho
- Department of Urology, Hospital Universitario Sanitas La Moraleja, Universidad Francisco de Vitoria, Madrid, Spain
| |
Collapse
|
18
|
Bhatt M, Soneja M, Tripathi M, Biswas A. Curious case of fever of unknown origin. BMJ Case Rep 2018; 11:11/1/bcr-2018-227258. [PMID: 30567178 DOI: 10.1136/bcr-2018-227258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 58-year-old immunocompetent woman presented with fever and significant weight loss of 4-month duration. She had mild pallor; rest of the examination was unremarkable. Investigations revealed anaemia with raised inflammatory markers. Cultures, serologies, routine urine examination, bone marrow examination, contrast enhanced CT and two-dimensional echocardiography examination were unremarkable. An 18F-fluorodeoxyglucose positron emission tomography with CT (18F-FDG-PET/CT) scan was performed which revealed atypical heterogenous uptake in bilateral renal cortex. Subsequently, urine GeneXpert came positive for Mycobacterium tuberculosis with sensitivity to rifampicin. She responded to category 1 antitubercular therapy. The challenges in diagnosis of genitourinary tuberculosis, low sensitivity of conventional diagnostic tests and potential role of GeneXpert and 18F-FDG-PET/CT scan are discussed in this report.
Collapse
Affiliation(s)
- Manasvini Bhatt
- Junior Resident, Department of Medicine, All India Institute of Medical Sciences, New Delhi
| | - Manish Soneja
- Associate Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Associate Professor, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashutosh Biswas
- Professor, Department of Medicine, All India Institute of Medical Sciences, New Delhi
| |
Collapse
|
19
|
|
20
|
Mthalane NBA, Dlamini NNM. Multidetector computed tomography has replaced conventional intravenous excretory urography in imaging of the kidneys: A scoping review of multidetector computed tomography findings in renal tuberculosis. SA J Radiol 2018; 22:1283. [PMID: 31754491 PMCID: PMC6837772 DOI: 10.4102/sajr.v22i1.1283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 11/19/2017] [Indexed: 12/05/2022] Open
Abstract
Background Tuberculosis (TB) is a worldwide infectious disease burden, especially in non-developed countries, with increased morbidity and mortality among human immunodeficiency virus (HIV)-infected patients. Extrapulmonary TB is rare and renal TB is one of the commonest manifestations. The end result of renal TB is end-stage renal disease; however, this can be avoided if the diagnosis is made early. The diagnosis of renal TB is challenging because of the non-specific presentation and low sensitivity of clinical tests. Although the sequel of TB infection in the kidney causes varying manifestations depending on the stage of the disease, multidetector computed tomography (MDCT) is capable of demonstrating early findings. We performed a 20-year scoping review of MDCT findings in renal TB to promote awareness. Aim To identify specific MDCT imaging characteristics of renal TB, promote early diagnosis and increase awareness of the typical imaging features. Methods and material We searched published and unpublished literature from 1997 to 2017 using a combination of search terms on electronic databases. We followed the Joanna Briggs Institute guidelines. Results A total of 150 articles were identified, of which 145 were found through electronic search engines and 5 were obtained from grey literature. Seventy-nine articles that fulfilled our inclusion criteria were reviewed. These included original research, case reports, literature review, organisational reports and grey literature. Conclusion Multidetector computed tomography can reproduce images comparable with intravenous excretory urography; together with advantages of being able to better assess the renal parenchyma and surrounding spaces, it is important in suggesting the diagnosis of renal TB and clinicians should consider including MDCT when investigating patients with recurrent urinary tract infection not responding to usual antimicrobial therapy.
Collapse
Affiliation(s)
- Ntombizakhona B A Mthalane
- Department of Radiology, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Nondumiso N M Dlamini
- Department of Radiology, College of Health Sciences, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| |
Collapse
|
21
|
Abstract
A 60-year-old Chinese woman presented with intermittent, painless, gross haematuria and subsequently complained of persistent milky urine. The diagnosis of chyluria was confirmed after cystoscopy demonstrated ureteric milky fluid discharge which had elevated levels of triglycerides. The patient did not travel to filarial endemic areas and her serum circulating filarial antigen was negative. Intravenous pyelography with CT of the abdomen did not reveal any masses or obstruction. It was determined that her chyluria was non-parasitic in origin and her symptoms improved with a low fat, high-protein diet. However, her chyluria recurred 1 year later, resulting in hypoalbuminaemia and proteinuria. Her symptoms resolved and her albumin levels normalised with adherence to dietary modifications.
Collapse
Affiliation(s)
- Yuyang Tan
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| |
Collapse
|
22
|
Gaudiano C, Tadolini M, Busato F, Vanino E, Pucci S, Corcioni B, Golfieri R. Multidetector CT urography in urogenital tuberculosis: use of reformatted images for the assessment of the radiological findings. A pictorial essay. Abdom Radiol (NY) 2017; 42:2314-2324. [PMID: 28389790 DOI: 10.1007/s00261-017-1129-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Urogenital tuberculosis (UGTB) is the most common form of extrapulmonary TB and is responsible for a destructive inflammation of the renal parenchyma and urinary tract often leading to the loss of kidney function. For these reasons, the early diagnosis of this disease, once considered disappeared in developed countries, is very important to establish a prompt and efficient treatment. However, the subtle and non-specific symptoms, often represented by recurrent and persistent lower urinary tract symptoms, can confound and delay the diagnosis. Therefore, an adequate and comprehensive imaging study is necessary in patients with persistent urinary tract infections not responding to the antibiotics and can suggest the hypothesis although bacteriological and/or histologic analysis is required for a definitive diagnosis. In the past years, intravenous urography (IVU) has allowed a comprehensive study of the urinary excretory tract, promoting the knowledge of the radiological findings of this disease. Nowadays, computed tomography urography (CTU), with the implementation of multidetector (MD) technology, has replaced IVU in all its indications; the MDCTU improves the assessment of renal and urinary tract lesions using reformatted images [such as multiplanar reconstruction (MPR) and maximum intensity projection (MIP)]. Therefore, our paper aims to provide a guide for radiologist for searching the classic signs of UGTB on MDCTU, encouraging the use of the MPR and MIP reformatted images.
Collapse
Affiliation(s)
- Caterina Gaudiano
- Radiology Unit, Department of Diagnostic Medicine and Prevention, St. Orsola-Malpighi Hospital, Via Albertoni, 15, 40138, Bologna, Italy.
| | - Marina Tadolini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Fiorenza Busato
- Radiology Unit, Department of Diagnostic Medicine and Prevention, St. Orsola-Malpighi Hospital, Via Albertoni, 15, 40138, Bologna, Italy
| | - Elisa Vanino
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Simone Pucci
- Radiology Unit, Department of Diagnostic Medicine and Prevention, St. Orsola-Malpighi Hospital, Via Albertoni, 15, 40138, Bologna, Italy
| | - Beniamino Corcioni
- Radiology Unit, Department of Diagnostic Medicine and Prevention, St. Orsola-Malpighi Hospital, Via Albertoni, 15, 40138, Bologna, Italy
| | - Rita Golfieri
- Radiology Unit, Department of Diagnostic Medicine and Prevention, St. Orsola-Malpighi Hospital, Via Albertoni, 15, 40138, Bologna, Italy
| |
Collapse
|
23
|
Steinkeler JA, Sun MRM. Imaging of Infections of the Urinary and Male Reproductive Tracts. Semin Roentgenol 2017; 52:83-89. [PMID: 28606312 DOI: 10.1053/j.ro.2016.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Maryellen R M Sun
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
| |
Collapse
|
24
|
Pinto DS, George A, Kumar N, Hoisala VR. A case report of renal papillary necrosis due to tuberculosis—CT urogram and static MR urogram findings. BJR Case Rep 2017; 3:20150438. [PMID: 30363280 PMCID: PMC6159247 DOI: 10.1259/bjrcr.20150438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 08/19/2016] [Accepted: 11/17/2016] [Indexed: 12/23/2022] Open
Abstract
The urinary tract is a common site of tuberculosis, which causes significant morbidity in the form of chronic renal disease. T uberculosis is not only common in developing countries but with the spurt in the number of immune-suppressed patients and the increasing incidence of drug -resistant strains, an increase in the number of patients suffering from genitourinary tuberculosis is expected even in developed countries. Genitourinary tuberculosis occurs owing to haematogenous dissemination of tubercular bacilli. Urinary tract tuberculosis can result in complications such as ureteric stricture, chronic pyelonephritis and papillary necrosis, resulting in compromised renal function. This renal compromise makes it prudent to avoid contrast- enhanced studies if other alternatives are available. There is a dearth of-cases of papillary necrosis reported on static MR urogram. The authors report a case of tuberculosis complicated by papillary necrosis on both CT urogram and static MR urogram.
Collapse
Affiliation(s)
- Denver Steven Pinto
- Department of Radiodiagnosis, St Johns Medical College, Koramangala, Bangalore, India
| | - Arun George
- Department of Radiodiagnosis, St Johns Medical College, Koramangala, Bangalore, India
| | - Nidhi Kumar
- Department of Radiodiagnosis, St Johns Medical College, Koramangala, Bangalore, India
| | - V Ravi Hoisala
- Department of Radiodiagnosis, St Johns Medical College, Koramangala, Bangalore, India
| |
Collapse
|
25
|
Peddireddy V, Doddam SN, Ahmed N. Mycobacterial Dormancy Systems and Host Responses in Tuberculosis. Front Immunol 2017; 8:84. [PMID: 28261197 PMCID: PMC5309233 DOI: 10.3389/fimmu.2017.00084] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/18/2017] [Indexed: 12/15/2022] Open
Abstract
Tuberculosis (TB) caused by the intracellular pathogen, Mycobacterium tuberculosis (Mtb), claims more than 1.5 million lives worldwide annually. Despite promulgation of multipronged strategies to prevent and control TB, there is no significant downfall occurring in the number of new cases, and adding to this is the relapse of the disease due to the emergence of antibiotic resistance and the ability of Mtb to remain dormant after primary infection. The pathology of Mtb is complex and largely attributed to immune-evading strategies that this pathogen adopts to establish primary infection, its persistence in the host, and reactivation of pathogenicity under favorable conditions. In this review, we present various biochemical, immunological, and genetic strategies unleashed by Mtb inside the host for its survival. The bacterium enables itself to establish a niche by evading immune recognition via resorting to masking, establishment of dormancy by manipulating immune receptor responses, altering innate immune cell fate, enhancing granuloma formation, and developing antibiotic tolerance. Besides these, the regulatory entities, such as DosR and its regulon, encompassing various putative effector proteins play a vital role in maintaining the dormant nature of this pathogen. Further, reactivation of Mtb allows relapse of the disease and is favored by the genes of the Rtf family and the conditions that suppress the immune system of the host. Identification of target genes and characterizing the function of their respective antigens involved in primary infection, dormancy, and reactivation would likely provide vital clues to design novel drugs and/or vaccines for the control of dormant TB.
Collapse
Affiliation(s)
- Vidyullatha Peddireddy
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad , Hyderabad , India
| | - Sankara Narayana Doddam
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad , Hyderabad , India
| | - Niyaz Ahmed
- Pathogen Biology Laboratory, Department of Biotechnology and Bioinformatics, University of Hyderabad, Hyderabad, India; Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
26
|
Agarwal KK, Behera A, Kumar R, Bal C. 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Tuberculosis: Spectrum of Manifestations. Indian J Nucl Med 2017; 32:316-321. [PMID: 29142348 PMCID: PMC5672752 DOI: 10.4103/ijnm.ijnm_29_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The objective of this article is to provide an illustrative tutorial highlighting the utility of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG-PET/CT) imaging to detect spectrum of manifestations in patients with tuberculosis (TB). FDG-PET/CT is a powerful tool for early diagnosis, measuring the extent of disease (staging), and consequently for evaluation of response to therapy in patients with TB.
Collapse
Affiliation(s)
- Krishan Kant Agarwal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Behera
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, Division of Diagnostic Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
27
|
Raut AA, Naphade PS, Ramakantan R. Imaging Spectrum of Extrathoracic Tuberculosis. Radiol Clin North Am 2016; 54:475-501. [DOI: 10.1016/j.rcl.2015.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
28
|
Brunetti E, Heller T, Richter J, Kaminstein D, Youkee D, Giordani MT, Goblirsch S, Tamarozzi F. Application of Ultrasonography in the Diagnosis of Infectious Diseases in Resource-Limited Settings. Curr Infect Dis Rep 2016; 18:6. [PMID: 26781324 DOI: 10.1007/s11908-015-0512-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ultrasound (US) has vast potential in the field of infectious diseases, especially so in resource-limited settings. Recent technological advances have increased availability and access to ultrasound in low-resource settings, where the burden of infectious diseases is greatest. This paper collates the evidence for the utilization of ultrasound and evaluates its effectiveness in the diagnosis and management of a range of infectious diseases. This paper explores the role of ultrasound in population-based screening for specific diseases as well as highlights its benefits for individual patient management. We describe the common diagnostic signs seen on US for common and neglected parasitic, bacterial, and viral diseases. We proceed to document the emerging field of chest US which is proving to be a superior imaging modality for the diagnosis of specific pulmonary conditions. We conclude by discussing the efforts needed to formalize and rigorously evaluate the role of ultrasound in infectious diseases.
Collapse
Affiliation(s)
- Enrico Brunetti
- Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy.
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Tom Heller
- Department of Medicine, Klinikum Muenchen-Perlach, Munich, Germany
| | - Joachim Richter
- Tropical Medicine, Clinic of Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine University, Düsseldorf, Germany
| | - Daniel Kaminstein
- Department of Emergency Medicine and Hospitalist Services, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | | | | | - Francesca Tamarozzi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| |
Collapse
|
29
|
Dangi AD, Kodiatte TA, Kumar S, Kekre NS. A rare cause of anuria: Bilateral synchronous isolated mid-ureteric tubercular lesions. Indian J Urol 2015; 31:360-2. [PMID: 26604451 PMCID: PMC4626924 DOI: 10.4103/0970-1591.155801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A young female presenting with right flank pain, fever, raised creatinine and bilateral hydronephrosis was treated with antibiotics elsewhere, with presumptive diagnosis of bilateral pyelonephritis. She had partial relief in symptoms and her creatinine level showed an improvement. Three months later during evaluation at our center she had anuria, hypertensive crisis and pulmonary edema which were managed with emergency bilateral percutaneous nephrostomies. Cross-sectional imaging and ureteroscopy suggested bilateral synchronous intramural mid-ureteric lesions as underlying pathology. Histopathology of the ureteric segments during laparotomy revealed caseating granulomas suggestive of tuberculosis. This clinical presentation has not been previously described in urinary tuberculosis.
Collapse
Affiliation(s)
- Anuj D Dangi
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Alex Kodiatte
- Department of Pathology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Santosh Kumar
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nitin S Kekre
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
30
|
Sourial MW, Brimo F, Horn R, Andonian S. Genitourinary tuberculosis in North America: A rare clinical entity. Can Urol Assoc J 2015; 9:E484-9. [PMID: 26279721 DOI: 10.5489/cuaj.2643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although tuberculosis (TB) is the most common cause of mortality from infectious diseases worldwide, genitourinary TB in North America is rare. We review 3 cases of genitourinary TB diagnosed within the last 5 years. CASES The first case is that of a 76-year-old African-Canadian woman who was referred for percutaneous nephrolithotomy of right lower pole renal stones. Although renal TB was suspected, her initial urinary TB culture was negative. On follow-up imaging, she developed bilateral ureteral thickening and ureteroscopic biopsy confirmed necrotizing granulomata. Repeat urine cultures were positive for M. tuberculosis. The second case is a 73-year-old Italian-Canadian woman who was referred for ureteroscopic biopsy of left thickened ureter to rule out urothelial carcinoma. Initial urine TB cultures were negative, despite biopsies confirming granulomatous inflammation. She was closely followed with urine cytologies and TB cultures. Repeat urine culture was positive for M. tuberculosis. Both patients were treated with a course of anti-tuberculous agents and indwelling ureteral stents to relieve ureteral obstruction. The third case is a 70-year-old Cree woman who was referred for percutaneous nephrolithotomy of a left "staghorn stone" in an atrophic left kidney. Thirty years earlier she had been treated for pulmonary TB in addition to ileocystoplasty for a "thimble" bladder. A computed tomography scan showed autonephrectomized left kidney. Her urine TB cultures were negative. She was placed on prophylactic antibiotics for her recurrent bacterial urinary tract infections. CONCLUSION Genitourinary TB may present in various subtle ways, and the astute clinician must have a high index of suspicion for this disease in patients with atypical clinical and radiologic findings. In addition, TB urine cultures should be repeated when there is high index of suspicion.
Collapse
Affiliation(s)
- Michael W Sourial
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC
| | - Fadi Brimo
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - Ruth Horn
- Department of Microbiology, McGill University, and Division of Infectious Diseases, McGill University Health Centre, Montreal, QC
| | - Sero Andonian
- Division of Urology, Department of Surgery, McGill University Health Centre, Montreal, QC
| |
Collapse
|
31
|
A 68-year-old woman with recurrent cystitis. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 26:e59-61. [PMID: 26015798 PMCID: PMC4419823 DOI: 10.1155/2015/761829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
32
|
|